Monday, February 14, 2011

My experience with breastfeeding (so far)

Before I get into the details of this, I have to say that I'm a little wary about posting about this topic. The last three weeks have involved an onslaught of information from a ton of different people, many of them experts in the field, and much of it conflicting or at the very least involving incompatible suggestions and approaches. This is one of the very few topics where I feel that Google has failed me; every website contains such different information that it is impossible to get any clear understanding of best practices, and instead research becomes overwhelming. At this point I feel totally maxed out on suggestions, resources, and new approaches. I have hit the limit of new websites I'm willing to check out and new people I'm willing to turn to for advice.

However, I'm posting about it anyway for several reasons: a) we now have a lactation consultant we trust and a plan that is working for us and that seems to be sustainable in the long term; b) when I first posted on Twitter about our breastfeeding issues, the outpouring of support was so helpful and encouraging, and I think that this supportive blogging community is the one place that I am not yet maxed out on discussing this issue with, even if this post does generate a few comments that I'm not prepared to deal with; and c) this has been a very important, if challenging, experience for me and I want to record it and share it in hopes that others can relate.

So! That giant disclaimer out of the way, let's talk about my breastfeeding experience.

At one day old Callum was diagnosed with a mild case of jaundice. The way to get rid of jaundice is for the baby to pee and poop out the excess bilirubin in his system. The newborn has 24 hours to pee before the doctors start getting concerned, and Callum didn't pee for the first time until more like 36 hours. And, even when he did start peeing, it wasn't very much or very often, and his bilirubin levels stayed elevated. Meanwhile, I was producing only a couple drops of colostrum at a time. I thought this was totally normal; everything I'd read said that you only produce a bit of colostrum until your milk comes in, but that it's all the baby needs. But the hospital seemed to feel otherwise. One nurse told me that I should be producing multiple teaspoons of colostrum at a time. The lactation consultant came in and pronounced that there were several "red flags" about my ability to breastfeed: the low colostrum production; the fact that I have a thyroid issue (though it is well-controlled); the fact that my breasts are "widely spaced"; the fact that my breasts didn't grow during pregnancy, although my nipples did. (Others have since told me that all of this information was actually inaccurate.)

There were also some positive signs: when I nursed, we could hear Callum swallowing, though not that often; his glucose levels remained stable; he only lost 3% of his birth weight before discharge. But nobody focused on those. Because of his jaundice, the baby needed to eat; I wasn't producing food to give to him, so we started him on formula supplements. I refused to give him a bottle because of everything I'd read about subsequent latch issues and nipple confusion, so first we tried a supplemental nursing system (SNS).

The SNS seemed like a great idea--basically it's a bottle of formula with a very small tube that is taped to the mother's breast so that when the baby suckles at the nipple, he also pulls in formula from the bottle. That way he is still stimulating the mom's milk supply and getting the nursing experience, but also getting the extra nourishment that he needs. But in practice, it was a huge pain in the ass. We only had the disposable one, which required two people to work: me to nurse with the tubes taped to my breasts, and Torsten to hold the bottle upright and pinch off the flow to the tubes whenever Callum stopped suckling so that milk wouldn't keep pouring into his mouth and all over his face. It was really hard to attach the tubes correctly so that they ended up in the right part of Callum's mouth when he latched. The tubes were also incredibly narrow so that the formula passed through them very slowly, meaning that every feeding took an hour or more. Plus, as we discovered later, Callum wasn't getting enough food through them, so he kept waking up hungry even shortly after being fed. You can imagine how fun it was for both of us to get up every hour or two all night long our first night home and spend an hour trying to feed our baby together.

The day after our first night at home, Callum had a pediatrician appointment at which we discovered that he had lost another 5 ounces since his discharge the previous day. The pediatrician was not happy about this, even though he had still lost less than 10% of his birth weight overall, and started talking about switching to a bottle. This was after Callum had been screaming in the waiting room because he was hungry, and I had been trying to nurse him and he kept latching and pulling off because there was no milk yet. We did this over and over again while he screamed and eventually he was crying and I was crying and then the pediatrician was talking about bottles and that just sent me over the edge.

So, on the way home from the pediatrician I called our Bradley childbirth class instructor, who is also a lactation consultant, and she totally saved my life. She talked me off the ledge and gave me a workable plan. She suggested that we dump the stupid SNS and switch to syringes, which would allow us to feed him more efficiently without worrying about nipple confusion. So we did that, he ate great, and when we went back to the pediatrician for a follow-up appointment the next day he had gained 5 ounces, so that was good news.

Then we started the process of trying to nurse him as often as possible to get my supply to come in, and cut down on his formula in hopes of weaning him off it entirely. At this point my milk seemed to be in, sort of: there was definitely something, but it was hard to tell how much. I wasn't engorged, I wasn't leaking, I never felt let-down, I didn't feel pain or fullness. We rented a Medela Symphony from the hospital, but when I pump, almost nothing comes out. I could hear Callum swallowing when he nursed, but not that much. And he hadn't pooped in several days, though he was peeing regularly. It was also hard with the syringe because it felt kind of like we were fattening up a goose--we were basically shooting formula directly down his throat, and while he happily took all that we gave him, it was really hard to tell how much he actually needed and how much he was eating just because we were pumping it into his mouth.

At 10 days old, with my milk supply still in the same questionable state, we went back to the pediatrician for Callum's two-week visit. Having not loved the first provider we'd seen, we switched to someone else, who we liked much better. She was great and very supportive and spent over an hour with us, discussing the situation. Callum had lost two ounces since his previous appointment, so that wasn't good, and she suggested a new feeding plan: nurse him every 2-3 hours, and not more often, because if he snacks all the time he will never fully drain my breasts and they won't be fully stimulated to refill, and give him a bottle after every other feeding. At that point he seemed to have a good enough latch that there was no concern about nipple confusion.

So, we went home and started this plan, and it worked pretty well. By the beginning of last week, he was back to his birth weight, which made the pediatrician happy. He had no latch confusion issues, but his nursing still wasn't awesome. Sometimes he would happily latch and suckle for 15 minutes each side. Sometimes he would be really sleepy and not willing to latch. And sometimes (and these were the worst times) he would scream and scream and scream and be in total hysterics and it would take me 45 minutes to an hour to calm him down enough to latch. And no matter which of the three it was, I always had milk left after he was done, and he would always drink several ounces of formula afterward, which was very disheartening. But at least he was eating.

So, last Wednesday I took the pediatrician's referral and went to see a new lactation consultant, who is also an MD, at the local children's hospital. And it was like FINALLY there was someone who listened, who paid attention, who saw what was happening, who was encouraging and helpful and suggested a truly sustainable plan of action. And things have been SO MUCH BETTER since then.

First, she took one look at Callum's latch and said it was way too shallow. He wasn't latching on deep enough to pull down a lot of milk, which is why I always had milk left even when he was nursing for 15 minutes per side. She was very surprised to hear that I hadn't experienced any pain while he was nursing, given how shallow his latch was. She checked in his mouth and said that his lingual frenulum was too tight, preventing him from opening his mouth wide enough to latch properly, and also from sticking his tongue out far enough to suckle properly. The convenient thing about having her be in the hospital is that she was able to page the ear-nose-throat doctor on call and he came down and cut the frenulum that same day. She also had us start using a nipple shield to teach him to open his mouth wider when nursing.

She also said that in general he is a very laid-back baby, which is great in a lot of ways but not when he's nursing. He is very lackadaisical about nursing, and will often stop nursing entirely and every effort I make to stimulate him to start again won't work. Lactation consultants, nurses, and doctors had suggested all different ways of stimulating him: his face, his ear, his clavicle, his hands, his belly, his feet--but this lactation consultant suggested pulling gently on his arm and moving it back and forth, and that is the only thing of all these suggestions that has actually worked.

She did say that I have a somewhat compromised supply--and we may never get to an exclusive breastfeeding relationship--but that I definitely have enough milk to make it worthwhile for both him and me, and that even if we always have to supplement with formula, I should definitely keep nursing too. And it was so encouraging to hear that. By the time I met with her, I was mentally preparing myself to be told that I had no milk to speak of and should just give up on the nursing thing altogether. And it was really nice to be told that I do have milk, even if it's not a ton.

AND she told me that if he screams, it is absolutely not worth trying to get him to nurse. She said if he is hysterical we should give him a bit of formula and see if that takes the edge off and makes him willing to nurse. If not, just try again later. So far since then he has only had one screaming fit, and after half an ounce of formula he was perfectly happy to settle in and nurse for half an hour.

She told me something that has really stuck with me: the first rule of feeding is that the baby needs to be fed, and the second rule is that the parents need to enjoy feeding him. This principle is so helpful to refer back to whenever we are struggling with the feeding. Callum is fed, he is gaining weight and he is healthy, and after that the goal is to find an approach to feeding him that we are all comfortable with.

So since then things have been so much better. His latch is much wider and with the arm thing I have consistently been able to motivate him to be a much more efficient eater. He pretty much always nurses for half an hour, and I know that he's getting milk, even if it's not a ton. He's still eating plenty of formula, but that's totally OK.

The thing about these struggles is that I wasn't expecting the emotions that would come along with them. When I was pregnant I read this great article about breastfeeding vs. formula feeding, and I thought after reading it that if breastfeeding ended up not working for us, I would be OK with that. I didn't realize how emotionally attached I was to the idea of breastfeeding, or how much of a failure I would feel when I thought that it wasn't going to work for us.

But the thing is that when I sat down and tried to work through my feelings about the whole thing, I realized that the vast majority of reasons I wanted to breastfeed had a lot more to do with me than with Callum. Breastfeeding is great, and it's good for the baby--but formula provides everything that he needs. I do want him to breastfeed so that he can get my antibodies, especially while he's too young to be vaccinated. But most of the other reasons are really about me. I like the convenience of it, and the fact that it's free. I like the relationship that comes from it--but I think that same relationship, or a very similar one, can be built through bottle-feeding. And honestly, I wanted the weight-loss benefits of the extra calories burned.

I had a conversation with Nilsa (who's been through somethingsimilar) last week about this whole experience and she pointed something out that really resonated with me: this is just the first of many times as parents that we will need to take a step back and ask if our concerns are actually about our child's health and well-being or if they have more to do with our own expectations. It's a lesson that we all have to learn, as parents, and while I certainly would have been thrilled if we'd been able to have a straightforward exclusive breastfeeding setup, and would not have minded learning this lesson just a little bit later, I do think the experience has been good for me. Though I still wouldn't choose it.

I'm still hopeful that now that Callum can open his mouth fully, and now that he's nursing more efficiently, my milk supply will increase. But an exclusive breastfeeding relationship doesn't seem to be in the cards for us at the moment, and I'm OK with that. I still feel a pang every now and then when I hear another mom say that her baby has never eaten anything but her breast milk, but that's just not how it's going to be for us. And that's fine too.

And lastly, some more photos, because I hear that it's a prosecutable crime to write a post about a baby and not include pictures:

32 comments:

And I'm so glad you finally found someone who told you what you needed to hear: The baby needs to be fed and you have to be happy doing it. If a baby has a stressed out, unhappy momma, he'll be stressed and unhappy. I learned that the hard way with my first.

Oh honey! I read this and it was almost exactly my story. My little guy lost 13% of his birth weight in the hospital, he had the feeding tubes attached to my breast and all of the fun stuff attached to that. It did get better, but I really do know how you feel right now. And I hope it gets better for you. I hope you don't mind me saying this, but did your doctor mention going on something like domperidone? It really helped my milk supply come in a bit more. We still supplement with a bottle (4oz) at night, but he's on just breast milk the rest of the time. My fingers are crossed for you. I know how I felt and it was pretty awful with washing out the feeding tube and feeling like I was just stuffing him with formula, which made him gassy and he didn't poop every day, it was more like every other day, so when he did, they were epic. It does get better! My little man is now up over 13 lbs and happy and healthy! I know that things will get better for you!

I like reading experiences like yours (not because it's ideal, but because it's real). After I had my son in October of 2008 (via cesarean), I had "twisted intestines" and gallstones. Until I had my gallbladder taken out in January of 2009, NOTHING I would eat or drink would stay "in" or "down". I lost 40 pounds in three weeks and never produced any notable amount of milk. It was SO HARD to admit defeat and formula feed. I was so guilt ridden and disappointed. But, like you said, while breastfeeding is so very awesome, it is not the end all. I'm glad to hear that you guys have found what works for you. And I can't wait to see more pictures of your cutie pie!

First of all, I am so so glad that you've finally found someone who can help you come to a decision that is comfortable for you. It makes me angry that the nurse that first talked to you was so negative (and wrong! The baby's stomach can only hold about a teaspoon at a time at that age; why would you produce "multiple teaspoons"? That makes no sense). People need to keep their mouths shut when they don't know what they are talking about. In regards to your feelings about this, I think it falls under the same type of feelings that Kelly at Temerity Jane (http://temerity-jane.com/unidentified-fetal-oriol/i-have-exchanged-my-jeans-of-triumph-for-floppy-pants-of-defeat/) and I (http://www.totallyserial.com/blog/2011/01/plans/) both had. Mine was about the guilt and shame that I felt because I wasn't able to have the vaginal delivery I wanted, and Kelly's is about being on bed rest and feeling like her body isn't providing as good of a "hut" as her baby needs. But they are all about feeling guilt and shame over something that we have no (or very limited) control over. All that is to say I totally get it. It is not your fault, and I hope that you can come to peace with that. It sounds like you are getting there. I'm so so glad you have found a way to get some breastmilk for Callum. Really, we all try our best, and that's all we can do.I assume that in doing your research and stuff you've seen this suggested, but just in case, have you considered trying Fenugreek? It's an herb (I think), and it's supposed to help increase milk supply. I hear that it works, but also that it makes you smell like maple syrup (maybe not so bad??). Feel free to ignore me, though, if that is unhelpful for whatever reason.

I'm so happy for you all that you've found someone you trust who listened to you and who seems to have found a workable solution for all. Breastfeeding was the thing I was most scared about (even more than birth) and after we were discharged from the hospital, we found our way and it worked out for us. Our time in the hospital was not good, though, and were it not for the devotion and patience of a nurse who had a 6 month old (all the LC were off for the weekend), I would have given up.

Doesn't it make you wonder how people did it hundreds of years ago? I mean, women have been birthing/nursing babies for thousands of years. But when issues like this arise, how did they handle it?

THANK YOU so much for this post!! I am only about two weeks from delivery and it really helps to hear a REAL story. I'm hoping (as you did) for the best, but am prepared to be "ok" if I am unable to breastfeed. But your post surely reminds me that everyone I encounter with an opinion is NOT an expert and that I need to find the person that HEARS my issues and addresses them. I really appreciate your taking the time to tell this story. And your baby is just beautiful and plump and precious and I would be forced to pinch his cheeks in person!!!

What an ordeal, and what a satisfying resolution. And then what a fun turn into a Bigger Picture sort of thing! This was a really, really good post, and I'm glad you're risking the potential bad comments because someone else who Googles might find THIS.

I think every mother's experience with birth and breast feeding and parenting is uniquely their own. Through a lot of research and pure determination, I hope you have found helpful resources and a path of least resistance that will allow you to enjoy and feel fulfilled with breastfeeding/feeding/nurturing Callum. You deserve it. So does he.

SO, SO similar to my experience with my first. SNS, low supply, jaundice... Except that I gave up after 2/5 weeks. I was better for it - so much relief. The emotional stress was too much for me. And I totally identified with you re: the pediatrician appt.s, feeling like a failure, and that some lactation consultants just aren't a good match!! I'm so glad you're sticking it out, and finding what works for YOU, and

I am glad things are getting better. What a rough start! I am really impressed with your perseverance.

So glad you have a good LC. Like other folks, I was wondering if she said anything about galactagogues, like fenugreek or eating oatmeal. I find this personally helps my supply, but everyone is different. And maybe these are old wives tales? Unsure.

I'm so glad you got the advice you did from your MD lactation consultant. I've had friends go through similar ordeals with breastfeeding and when they reached out for help, the message they got was that they just weren't trying hard enough or that offering the bottle was some kind of failure. It's just such an unfair thing to do to a new mother.

Thanks for including the Callum pictures. He looks so alert and happy!

I'm so glad that you found an LC that actually HELPED and a paediatrician that you like. I also had a baby with a very shallow latch and who also had a very weak sucking reflex, so even when I managed to get the nipple in there properly, it often wouldn't stimulate the sucking reflex. We struggled mightily as well. It took me one month to find someone here that would cut her frenulum (in Canada they tend not to do that anymore - I had to find a doctor at a breastfeeding clinic) and after that, things improved a lot as well. I'm glad that things are working out for you.

This sounds like a cross between my first experience breastfeeding and my second.

My milk supply does not come in until the 5th day after birth (both of my babies where vaginal deliveries), which I believe is late but not unheard of. By this time, I find the doctors are already encouraging me to supplement.

With my first, breastfeeding was successful for us until I returned to work. My second was hospitalized shortly after her birth, and I never was able to establish with her. I basically pumped until she was eight weeks or so and put it in her bottle.

I am now expecting my third, and am so hopeful to have the breastfeeding experience I had always imagined. It really is hard to reconcile my expectations with the reality of what works best for my family. The TRUTH is that in the end, all that matters is everyone is happy and healthy. However, it is hard for me to completely accept that I haven't failed them in some way.

I did notice some improved supply with fenugreek - though you will smell like a pancake house all day everyday :)

That last LC sounds wonderful. Breastfeeding can be so, SO, frustrating when you get a million different suggestions and opinions and experiences. I'm so glad you guys are finally finding something that's working!

I felt emotional for you just reading this. All these new emotions as a mother are so normal even when the focus is individual to each parent and baby. Every mom has anxieties about their own failure whether it be about breastfeeding or sleep habits or cloth diapers or discipline (when they're older). Your friend was right that this is the beginning of feeling those feelings in one form or another and that we have to analyze whether our worries are about our own expectations or what is really healthy for our children. It is good for me to be reminded about that!I'm sorry you had such a tough time getting to a doctor who you felt would listen to you. I'm impressed with your tenacity to keep looking until you found the right provider! Callum will never lack for love, that's for sure. And you know what, some people say the weight falls off of you when you're breastfeeding but that was never the case with me. It still takes healthy eating and exercise and you've already proven you can do that.

First of all, Callum just gets more gorgeous with every picture you post.

Second of all, I'm glad you have found something that seems to be working for you!

My first experience, with my daughter, with breastfeeding was nearly perfect - although it is kind of hard to know that until you've had a less than perfect experience.

My second experience came on the heels of my son's premature birth and was complicated by all kinds of medical factors. He was never exclusively breastfed because he had to have a supplemental high-calorie formula. For us the question was whether to continue to breastfeed at all because for a while we were caught in a vicious cycle of trying to nurse, then feeding him a bottle, then pumping (to mix my milk w/ the supplemental formula and store my excess), then maybe I would have a twenty minute break before beginning all over again - and it was just not sustainable. Eventually we did find a way to continue to breastfeed some, until about six months. For me the best thing was to set a goal for how long I was going to try and give myself permission to let it go after that. As it turned out things were working a little better by then.

My experiences were vastly different with each child, but I love them both (of course) and all the things about bottle feeding that I dreaded with my daughter ended up not being so bad when I had to do them with my son. And he is the more cuddly, more bonded to me, of the two - which I think comes down to personality and probably has very little to do with how they were fed as infants.

Ultimately your baby's needs will be met and by doing that you are doing exactly what a good parent should.

Oh honey I am so happy to hear from you on this. I've been thinking about you a lot but didn't want to ask because I know it's been hard. I am so glad to hear you have found someone you like and trust. And honestly, you are one of the most well-adjusted, calm, logical people I've ever met. If I was in your situation I think my head would be spinning like a top! I am glad things are getting better and I hope you guys are just eating up all of that new baby love. He is just gorgeous.

Yes, yes, YES on the conflicting information. This is why my #1 advice to people breastfeeding is to find ONE "expert" they trust (and not a ped or family doctor, but someone actually, TRULY trained in lactation) and stick with that one person.

I'm so glad that you've found a solution that seems to be working for you. I understand being attached to the bfing experience, because I TOO felt that way when I was struggling with my twins.

Also, I'm so glad you shared this here. Surely it will help someone else.

All hail the nipple shield. Nursing has been successful for me, but only with the shield. And bless the LC who told me to stop worrying about trying to wean my baby from it if she was eating fine and gaining weight.

As for breastfeeding... I'm proud of you for sticking to what you want and for making it happen in a way that works for you AND sweet little piglet. Fed baby and happy mama is a combination for WIN! :)

wow, i had no idea most of the stuff in this post existed. nipple shields / frenulum cuts / the works. glad you've found someone who works with you, though! and thank you (as always) for the SO CUTE OMG PICTURES. i will now devolve into a pile of goo spouting phrases like LOOK AT THOSE CHEEEEKS and LET ME AT THOSE THIGHS NOM NOM NOM.

oh yeah, Oliver wasin the NICU for 9 days and since he had a tube in his chest, I couldn't lifet him out and breastfeed him so he never learned to latch on and still hasn't. I pump and then supplement 1 formula bottle a day. Took me sometime to get voer the feeling of disappointment that my child did not want to nurse at my breast. But, he needs to gain weight and be healthy and here's hoping he doesn't grow up to be a mother hating serial killer because he didn't drink milk directly from my boob.

Good for you for coming to terms with what you need to do for the healthy well being of both you and the baby. And, btw, he's absolutely adorable!

Ohmygosh! I could write a novel of a comment here, but I'll try to contain myself. The conflicting information early on was so very hard for me. I really felt like I had to figure out everything all on my own, and that's how I ended up as an exclusive pumper. By the time I found a lactation consultant worth her salt, I was already back to work. Nursing just wasn't happening for us.

But, by far my favorite thing my wonderful LC has ever said is that formula is just another kind of food to feed your baby. Definitely helps ease my (oh so silly) guilt about supplementing.

Just popping in the say that you have one of the cutest babies I've ever seen. Truly.

And I just...feel for you with the rest of it. Breastfeeding is hard. And before they had lactation consultants, people lived near their mothers and aunts and a whole slew of family that all had breastfed and could give advice and etc. A whole TEAM of people. And they still needed wetnurses some of the time.

And what a good way to look at this as the start of many parenting decisions to come. Because I still feel like the best laid plans...kids throw a wrench into them all the time. ;)